1.
RH GROUP PRESENTATION
PRE-ECLAMPSIA

2.
GROUP MEMBERS
• DIANA KONJI
• ELIUD KIPRUTO
• KELVIN MURUNGA
• CETRICK RAMA
• LUCY VERA
• TIMOTHY SHAYO
• LEAH WASIMBI
• LEVY KWANGU
• RODGERS NAMATSI
• PERKINS SUNGU

3.
BIODATA
• NAME: EUNICE LAVANGA
• AGE: 37YRS
• RESIDENCE: CHEKALINI
• RELIGION: CHRISTIAN
• OCCUPATION: HOUSEWIFE
• MARITAL STATUS: MARRIED
• DOA: 27/11/2022
• BED NO: 6
• LMP: 17/05/2022
• PARITY: 3+0 GRAVIDA 4
• GBD: 28WKS 3DAYS
• EDD: 24/02/2023

4.
CHIEF COMPLAIN
• BLURRED VISSION 2/7
• HEADACHE 2/7

5.
HPI
• This is a referral case from Chekalini Health center due to high Bp 217/132mmHg
with PR of 120beats/min . The patient was put on methyl dopa and labetalol stat
dose.
• She presented with bilateral blurred vision for 2 days which was of sudden onset,
continuous with no timing no aggravating or relieving factor . It was associated
with general body weakness. No history of previous blurred vision, no history of
trauma , no history of ocular pain or eye discharge.
• There is no hx of PND no hx of nocturnal cough, no hx of heartbeat awareness
• She also presented with headache for 2 days of sudden onset throbbing in nature
non radiating . There was no associated factor , no relieving or aggravating factor.
No history of confusion no history of loss of conciousness , no history of trauma .
• There is no hx of lower limb swelling, no hx of abdominal pains

6.
REVIEW OF OTHER SYSTEMS
• RS
• No history of cough
• No history of chest pain
• No hx of DIB
• GIT
• No history of abdominal pain
• No history of vomiting
• No history of diarrhea
• No history of nausea

7.
CONT.
• GUT
• No oliguria
• No painful urination
• No history of blood in urine
• MUSCULOSKELETAL
• No muscle stiffness
• No joint stiffness

8.
OBS HX
• Parity 3+0
• Gravida 4
• LMP: 17/05/2022
• EDD: 24/02/2023
• GBD: 28WKS 3DAYS

9.
CONT,
• First delivery 2008 at hospital SVD female alive
• 2nd 2014 at hospital SVD female alive
• 3rd 2017 at hospital SVD male alive

10.
ANC PROFILE
• Blood group O
• Hb 12.1g/dl
• Rhesus +ve
• HIV test: None reactive
• Urinalysis : NAD
1st visit 15/09/2022 BP 113/67mmHg IFAS, malaria prophylaxis given
2nd visit 19/10/2022 BP 132/76mmHg IFAS routine tests done
3rd visit 27/11/2022 BP 214/143mmHg fetal and maternal well being
assessed

11.
GYN HX
• Menarche at 16 yrs
• Menses are of regular flow for 3 days
• She uses 3 clothes {t-shirts} per day
• Thelarche at 16 yrs
• Puberche at 16 yrs
• This is her fourth pregnancy
• She has one sexual partner.
• She reports of having used depo[ contraceptives] 3 months.

12.
PAST MEDICAL AND SURGICAL HISTORY
• This is her second admission
• 1st admission was on 2017 due to typhoid and was well managed.
• No known hx of food and drug allergy
• No hx of blood transfusion
• No hx of surgery

13.
PERSONAL AND SOCIO-ECONOMICAL HX
• She is a housewife
• Married, husband is a casual laborer
• Studied to form 4
• Lives in a well ventilated house
• Has NHIF and Linda mama cover
• She does not smoke nor takes alcohol
• Drinks treated tap water

14.
FAMILY HISTORY
• 1st borne in a family of 10
• 9 alive and well
• 1 died of an illness not known to her
• Both parent alive
• Mother suffering from hypertension and on medication

15.
SUMMARY
• This is Eunice Luvanga para 3+0 gravida 4 a referral from chekalini
health center who presents with bilateral blurred vision and
headache for 2 days. She is currently doing day 4 post admission. She
reports of improvement since she can see clearly and the headache
has subsided.

16.
GENERAL EXAMINATION
• The patient is well groomed in good general condition, good
nutritional status and oriented to time place and person.

17.
VITALS
• BP: 132/89mmHg
• Temp: 36.7
• Spo2: 94%
• PR: 94 beats/min
• RR: 15breaths/minute

18.
PHYSICAL EXAMINATION
• No pallor
• No cyanosis
• No lymphadenopathy
• No jaundice
• No facial or pedal edema
• No dehydration

19.
SYSTEMIC EXAMINATION
• PER ABDOMEN EXAMINATION
• INSPECTION
• Moves with respiration
• Linear nigra present
• Umbilicus everted and centrally placed
• No therapeutic marks
• Striae gravidarum present
• AUSCALTATION
• Fetal heart rate 132 beats/minute
• PALPATION
• Abdomen soft and non tender
• Fundal height at 26 weeks
• Palpable mass

20.
CONT
• Longitudinal lie
• Breech presentation

21.
IMPRESSION
• SEVERE PRE-ECLAMPSIA
• Ddx
• Chronic hypertension
• Sub arachnoid hemorrhage
• Gestational hypertension
• Hyperthyroidism
• Subdural hematoma
• Thrombotic thrombocytopenia purpura

22.
INVESTIGATIONS
• FHG
• UECs
• LTFs
• Ultrasound
• Urinalysis:-App; umber
-ketones; negative
- glucose; neg
-nitrites; neg
-bilirubin; neg
- blood ++
-leukocytes;neg
-pH 5.0
- SG; 1.015
-proteins +

23.
ULTRASOUND REPORT
• Number of fetus 1
• Presentation breech
• Lie longitudinal
• Fetal hrt rate 125bts/min
• Liqour adequate
• EFW 1080 grms
• AVG 27 weeks 4 days
• BPP 8/8

24.
MANAGEMENT
• PATIENTS MONITORING
• Bed rest
• Reduce sodium intake
• BP monitoring 4hourly
• Regular screening for proteinuria
• Regular FBC,UECs & LFTs
• Cathetarize and monitor urine input output
• FETAL MONITORING
• Daily fetal kick chart
• Fetal HR monitor half hourly
• Ultrasound biophysical profile

25.
DIAGNOSIS
• SEVERE PRE-ECLAMPSIA

26.
DEFINITIVE MGT
• MgSO4 4g infusion loading dose over 10-15 min: maintenance dose
1g/hr IV till postpartum
• Labetalol 20mg IV every 10-15 mins
• Nifedipine 10mg every 30 mins orally
• Deliver at 34 weeks in presence of maternal or fetal complications
• Give dexamethasone for fetal lung maturity